MEDICARE: DR. SETH ELLIOTT D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	12905	TX

General Provider Information

NPI Number	:	1598150559
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SETH ELLIOTT D.C.

Provider Business Mailing Address
First Line	:	2428 FOREST PARK BLVD STE A
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76110-1781
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2428 FOREST PARK BLVD STE A
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76110-1781
Country	:	US
Telephone Number	:	682-703-1529
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/06/2015
Last Update Date	:	07/02/2015

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